arthrosis

Arthrosis - what is it in simple words?

Arthrosis is a chronic pathology in which the gradual destruction of the cartilage plate occurs. Pathological changes affect the underlying bone, which becomes more compact and marginal growths (osteophytes) develop. The joint capsule reacts to the events that occur and reactive vasculitis develops.

About the disease and possible complications

The incidence of pathology depends on age. The first signs of arthrosis usually appear no earlier than 30-35 years old, and at the age of 70, about 90% of the population suffers from this pathology. Arthrosis shows no gender differences. The only exception is degenerative joint damage between the phalanges of the wrist. This form of the disease is 10 times more common in women compared to men. Arthrosis most often affects the large joints of the legs and arms.

The pathological process begins with the interstitial substance of cartilage tissue, which includes type 2 collagen fibers and proteoglycan molecules. The normal structure of the interstitial substance is maintained by balancing the processes of anabolism and catabolism. If the process of breaking down cartilage tissue dominates its synthesis, then conditions are created for the development of osteoarthritis. This explains in simple terms what arthrosis is.

Most often, the first signs of the disease develop in places with greater mechanical load, with limited areas of softening of the cartilage plate. As the pathological process progresses, cartilage fragments and cracks, as well as local deposition of calcium salts are possible. Beneath cartilage defects, the underlying bone is exposed; separated fragments of cartilage enter the articular cavity and can lead to so-called "blockage" (symptoms of a "joint rat").

Damage to the cartilage that lines the articular processes of the bones leads to the fact that they lose their ideal shape, repeating the contours of each other. As a result, during movement, the articular surfaces experience non-physiological loading. In response to this, compensatory resynthesis processes are stimulated in the bone tissue. The bone becomes denser (subchondral osteosclerosis develops) and irregularly shaped marginal growths (osteophytes) appear, which further alters the misalignment between the articular surfaces. Pathological changes that develop gradually limit the range of motion in the joint and contribute to the development of complications in the form of muscle contractures (secondary muscle spasm that occurs in response to pain).

Arthrosis becomes the background for the development of synovitis - inflammation of the synovial membrane of the joint. This is due to the fact that dead cartilage and bone fragments activate phagocytic leukocytosis, which is accompanied by the release of pro-inflammatory mediators. Over time, such long-term inflammation is associated with sclerosis of periarticular tissues - the joint capsule thickens, the surrounding muscles atrophy.

The main symptom of arthrosis is pain, which over time is accompanied by limited movement in the joint. The limitation of mobility is first of compensatory functional nature and then due to organic changes. Additional diagnostic imaging methods (radiography, ultrasound scan, computed tomography or magnetic resonance imaging) help to establish the correct diagnosis.

Depending on the stage and degree of arthrosis, treatment can be carried out using conservative or surgical methods. An orthopedic traumatologist will help you choose the optimal treatment program that takes into account the individual characteristics of the patient.

Types of arthrosis

There are 2 types of arthrosis:

1. The primary variant is a consequence of a violation of the relationship between the processes of synthesis and degeneration in cartilage tissue and is associated with a disorder of the function of chondrocytes - the main cells of cartilage.
2. The secondary variant occurs in a previously modified joint when the normal relationship (congruence) of the articular surfaces is broken, followed by a redistribution of the load on them and with a concentration of pressure in certain areas.

Symptoms of joint arthrosis

The main symptom of arthrosis of the joints is pain. It has several distinguishing features that allow the primary diagnosis of the disease.

1. Mechanical pain, caused by the loss of the absorbing characteristics of the cartilage. Painful sensations appear during physical activity and are relieved during rest.
2. Night pain.Caused by stagnation of venous blood and increased blood pressure flowing inside the bone.
3. The onset of pain.It is short-lived and appears in the morning when a person gets out of bed (the patient says it should "dissolve"). These pains are caused by the deposition of debris in the cartilage plates; during movement, these fragments are pushed into the articular inversions, so the unpleasant sensations stop.
4. Meteor dependence.Pain can intensify when weather conditions change (increased atmospheric pressure, cold weather, excessive humidity).
5. Blocking pain.These are sudden painful sensations that are associated with the compression of a fragment of bone or cartilage between the articular surfaces. Against the background of "blockage", the smallest movements in the joint stop.

The nature of the pain changes somewhat when secondary synovitis occurs. In this case, the pain becomes constant. In the morning, a person is bothered by stiff joints. Signs of the inflammatory process are determined objectively - swelling and a local increase in skin temperature.

Osteoarthritis usually begins slowly with the onset of pain in an affected joint. At first, the pain bothers you only during physical activity, but later it also appears at rest and during night sleep. Over time, pain is also felt in the joints of the opposite side, which is accompanied by a compensatory increase in load. An important distinguishing feature of arthrosis is its frequency, when short periods of irritation are followed by periods of remission. The progress of the pathological process is indicated by a shortening of the recovery period and the development of negative consequences in the form of contractures and a sharp limitation of joint mobility.

The course of arthrosis during pregnancy

During pregnancy, arthrosis can appear in different ways. Usually, up to 12-13 weeks, a worsening of the pathological process can occur, accompanied by hormonal changes occurring in the woman's body. The second and third trimesters are usually relatively stable. Pregnancy management is performed by an obstetrician-gynecologist and an orthopedic traumatologist.

Causes of joint arthrosis

The main mechanism that causes the destruction of cartilage is a violation of the synthesis of proteoglycan molecules by cartilage tissue cells. The development of arthrosis is preceded by a period of metabolic disorders, which appears hidden. This metabolic imbalance is characterized by damage to proteoglycans and their constituent components (chondroitin, glucosamine, keratan), which is accompanied by the breakdown and decomposition of the cartilage matrix. Collagen fibers are torn in the cartilage plate, the supply of metabolites necessary for life is interrupted, and the water balance also changes (first the cartilage is hydrated, and then the number of water molecules is significantly reduced, which further stimulates cracking).

Primary pathological processes negatively affect chondrocytes, which are very sensitive to the surrounding matrix. Changes in the qualitative characteristics of chondrocytes lead to the synthesis of damaged proteoglycan molecules and short chains of collagen fibers. These defective molecules do not bind well to hyaluronic acid, so they quickly leave the matrix. With arthrosis, a cytokine "boom" is also observed - the released cytokines disrupt the synthesis of collagen and proteoglycans, and also stimulate inflammation of the synovial membrane.

The main causes of arthrosis can be different:

• "Excess" weight, which increases the load on the joints;
• wearing low-quality shoes;
• accompanying diseases of the musculoskeletal system;
• suffered joint injuries.

Signs and diagnosis of joint arthrosis

Based on the clinical symptoms, the radiologist makes a preliminary diagnosis. To confirm this, additional imaging tests are performed.

1. Radiography.At an early stage, X-ray signs of the disease are of little importance - these can be uneven narrowness of the joint space, slight compression of the lower bone and small cysts in this area. At a later stage, radiography is more informative - marginal bone growth appears, the shape of the articular surfaces changes, articular "mice" and areas of calcification in the capsule can be determined.
2. Ultrasound of joints.Ultrasound scanning is more informative for detecting the initial signs of arthrosis. Signs such as intra-articular effusion, changes in the thickness and structure of the cartilage plate and secondary reactions of the capsule, musculotendinous and ligamentous compartments can be visualized.
3. Computed or nuclear magnetic resonance imaging.This diagnosis of joint arthrosis is carried out in complex clinical cases, when it is necessary to assess in detail the condition of the cartilage plate, the subchondral region of the bone and determine the volume of synovial fluid, incl. in articular inversions.

Expert opinion

Deformative arthrosis of the joints is one of the most common pathologies of the musculoskeletal system, which occurs in 10-15% of the world's population. The cunning of the disease is that it develops slowly and gradually. At first, these are short-term pains in a joint, which a person often does not pay attention to. Gradually, the severity of the pain syndrome becomes more intense, while the periodic nature of the pain becomes constant. In the absence of treatment, the disease continues to progress and is accompanied by severe cartilage degeneration, which no longer responds to conservative therapy, and to solve this problem, only arthroplasty is required - a complex and expensive intervention to replace the destroyed joint with afull joint. -leaf implant. However, targeted drug therapy and lifestyle modification can help significantly delay this surgery or avoid it altogether. Therefore, if joint pain occurs, it is important to see a doctor as soon as possible.

Treatment of arthrosis

According to clinical guidelines, the main goal of arthrosis treatment is to slow down the progression of degenerative lesions of the cartilage plate. To achieve this, measures are taken that reduce the load on the damaged joint and promote its recovery, and therapy is prescribed to stop the development of secondary synovitis.

Conservative treatment

Unloading the union is achieved in the following ways:

• loss of body weight (if excessive);
• performing physical therapy that excludes prolonged similar poses;
• refusal to lift heavy loads or to stay on the knees for long periods of time (important for some professions).

In the initial stages of the disease, in addition to physical therapy, swimming and cycling are useful. In the later stages, to unload the joint during an irritation, walking with an orthopedic cane or using crutches is recommended.

To relieve pain, incl. against the background of secondary synovitis, local and systemic non-steroidal anti-inflammatory drugs are used. Intra-articular corticosteroid injections can be used for the same purpose.

To improve the anatomical and functional state of the cartilage plate, chondroprotectors and hyaluronic acid preparations are used, which are injected into the joint cavity. They help improve cartilage tissue metabolism, increase the resistance of chondrocytes to damage, stimulate anabolic processes and block catabolic reactions. This allows you to slow down the progression of the pathological process and improve joint mobility.

Surgery

Surgical treatment options depend on the stage and activity of the pathological process.

• Joint puncture– indicated for severe reactive synovitis. It allows not only the removal of the inflammatory fluid, but also the introduction of corticosteroids that interrupt the pathological chain.
• Arthroscopic operations, which involve inserting instruments into the joint cavity through small punctures and subsequent visualization under magnification. These interventions make it possible to wash the joint and its inversions, level the cartilaginous plate, remove necrotic areas, "polish" the articular surfaces, etc.
• Endoprosthetics- it is considered a radical operation, which is performed in case of an advanced pathological process. It is typically used for osteoarthritis of the knee or hip joint.

Prevention of arthrosis

The prevention of arthrosis is aimed at maintaining a normal weight, wearing orthopedic shoes, avoiding work on the knees, lifting heavy objects and observing a physical activity regime.

Rehabilitation for joint arthrosis

Rehabilitation for joint arthrosis includes a number of procedures that can improve the functional condition of the joint and surrounding tissues. Physiotherapy, therapeutic massage and gymnastics are used to improve health.

Question and answer

Which doctor treats arthrosis?

Diagnosis and treatment is carried out by a traumatologist-orthopedic.

Does X-ray always allow the correct diagnosis to be made?

The severity of clinical signs of arthrosis is not always related to radiological changes. Often in practice there are cases when, with severe pain, radiography does not reveal significant changes, and vice versa, when a "bad" X-ray picture is not accompanied by significant symptoms.

Is diagnostic arthroscopy performed for arthrosis?

If arthrosis is suspected, arthroscopy is usually performed not to establish a diagnosis, but to look for causes that may lead to deterioration of the functional state of the joint (for example, damage to the meniscus of the knee joint and intra-articular ligaments). .